RESEARCH ARTICLE Open Access

Prevalence and trends of transfusiontransmissible infections among blooddonors in the State of Qatar, 2013–2017Mohamed Aabdien1* , Nagah Selim2,3, Sayed Himatt4, Saloua Hmissi5, Zeyd Merenkov5, Noora AlKubaisi2,Manar E. Abdel-Rahman6, Abdelatif Abdelmola7, Shadi Khelfa7, Elmoubasher Farag4, Hamad E. Al-Romaihi4,Mohamed Al-Thani4, Moutaz Derbala7 and Saad Al-Kaabi7

Abstract

Background: Millions of lives around the world are being saved annually through blood transfusion. However,blood transfusion is among the essential vehicles for transmitting infections. The overall prevalence of TransfusionTransmissible Infections among blood donors differs around the world, reflecting the variation in the prevalence ofthese infections. This study aims to assess the prevalence and trends of Transfusion Transmissible Infections amongblood donors in Qatar.

Methods: This is a cross-sectional study utilizing donation records of 5 years from January 2013 to December 2017.We included in the study results for all screening and confirmatory tests for Hepatitis B Virus, Hepatitis C Virus,Human T-lymphotropic Virus-I/II, Syphilis and Malaria.

Results: Among the 190,509 donations received at the donation centre during the study period, about 91% ofdonations were received from males and 9% from females. The overall positivity rate for all tests was 1.87, 2.23, 1.78,2.31, 2.67% for the years 2013 through 2017, with an increasing yearly trend by 6% each year. The overall positivityrates for Hepatitis C Virus, Human T-lymphotropic Virus-I/II, Hepatitis B Virus, Syphilis and Malaria (2013–2017) were0.60, 0.18, 0.30, 0.43 and 0.20%, respectively.

Conclusion: The overall positivity rate of all tests combined for the Transfusion Transmissible Infectionsdemonstrated a gradually increasing trend from 2013 to 2017. However, the trend for each infection (Hepatitis CVirus, Hepatitis B Virus, Syphilis and Malaria) was fluctuating except for Human T-lymphotropic Virus-I/II, which wasincreasing. Supporting the development of effective prevention and control strategies requires furthercomprehensive investigations for better estimation of the burden of these infections.

Keywords: Blood Donors, Transfusion, Hepatitis B virus, Hepatitis C virus, Human T-Lymphotropic virus, Syphilis,Malaria, Qatar

© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.

* Correspondence: MAabdien1@hamad.qa; Aabdien_Mohamed@outlook.com1Community Medicine Training Program- Medical Education, Hamad MedicalCorporation, P.O. Box 3050, Doha, State of QatarFull list of author information is available at the end of the article

Aabdien et al. BMC Infectious Diseases (2020) 20:617 https://doi.org/10.1186/s12879-020-05344-5

BackgroundBlood transfusion is a life-saving procedure that savesmillions of lives every year around the world, it can betransfused as whole blood for one patient or may bemanufactured into blood-derived products to be pro-vided for more than one patient. However, it is knownthat blood transfusion can be associated with risks oftransmitting certain infections [1, 2].These infections are known as Transfusion Transmis-

sible Infections (TTIs), which defined as any infectionthat can be transmitted from person to person throughparenteral administration of blood or any blood prod-ucts. Thus, different outcomes may follow unsafe trans-fusion, as it can cause an acute clinical sickness; it canpersist in the receiver as a carrier or cause asymptomaticinfection [3].These infections include viral, bacterial, parasites and

prions. The most prominent among these are, Human Im-munodeficiency Virus (HIV), Hepatitis B Virus (HBV) andHepatitis C Virus (HCV), due to their high prevalencerates. Other agents are Human T-cell Lymphotropic Virus(HTLV-I/II), Cytomegalovirus (CMV), Parvovirus B19,West Nile Virus (WNV) and Dengue Viruses, Trypano-somiasis, Malaria and Transmissible Spongiform Enceph-alopathy (TSE) [4].The prevalence of TTIs among blood donations varies

between high and low-income countries. It was reportedthat the prevalence of HIV, HBV, HCV and Syphilis inhigh-income countries are 0.003, 0.03, 0.02 and 0.05%,respectively. While in low-income countries, the preva-lence of these infections is higher; 1.08, 3.70, 1.03 and0.90%, respectively. These differences reflect the vari-ation in the prevalence of these infections among thepopulations of these countries [5]. These variations arealso observed between the World Health Organization(WHO) regions. As African and Pacific regions are thehighest in HBV prevalence, Eastern Mediterranean re-gion is the highest for HCV prevalence, Sub-Saharan Af-rica is the highest for malaria, and scattered foci insouthwestern Japan, Colombia and intertropical Africaare endemic for HTLV-1 [6–8].Many global efforts are provided to ensure the safety

of the whole blood transfusion process. These efforts in-clude providing recommendations and guidelines to es-tablish a national blood screening and surveillancesystem for the entire transfusion chain, i.e. haemovigi-lance system. Moreover, efforts are also provided for theestablishment of the Global Database on Blood Safety(GDBS), aiming to improve transfusion services globally[9, 10].In Qatar, Expatriates comprised a high proportion of

Qatar’s population, coming from all over the world, withdiverse and unique epidemiological characteristics foreach region. Enormous efforts aimed at protecting the

health of the population and prevention the spread of in-fectious diseases from newcomers. Among these effortsis the law that mandates all newcomers wishing to workand live in Qatar to undergo a medical exam and infec-tious diseases screening to be able to receive a residencepermit. Furthermore, specific job categories, includinghealth care personnel and food industry workers, are re-quired to undergo annual medical check-ups.The Blood Donor Center at Hamad Medical Corpor-

ation (HMC) is responsible for the provision of safeblood supply through the efforts provided to ensure thatdonated blood is free from infections. However, fewlocal epidemiological studies are assessing the prevalenceand trends of transfusion-transmitted infections amongblood donors, comprehensively. Hence, conducting thisstudy to assess transfusion transmissible infectionsamong blood donors can provide a better understandingof the epidemiology of these infections, which can sup-port strategies development to evaluate safe blood sup-ply measures, in addition to the preventive and controlmeasures that are needed to manage the burden of theseinfections in the community. Therefore, the study aimsto assess the prevalence and the trends of the transfu-sion transmissible infections among blood donors duringthe period 2013–2017, in Blood Donor Center at HMCin the State of Qatar.

MethodsStudy settingThe Division of Transfusion Medicine includes the BloodBank Section & Donor Unit. The Transfusion Division isthe only provider of blood and blood components in theState of Qatar. Its main function is to assure the availabil-ity of safe blood whenever needed. The centre followsinternational recommendations for the provision of safe,efficacious blood products and transfusion. In September2017, HMC’s committee for blood transfusion announceda new program for monitoring blood transfusion processin the country. The Centralized Hemovigilance Programaims to improve the quality of the blood transfusion chain,with the main focus on safety.The program was initially implemented at HMC and

was introduced across all healthcare facilities around thecountry, that collect, use or store blood and its products.All donated unit samples undergo screening tests priortransfusion for the following infectious, through follow-ing methods: Chemiluminescent Microparticle Immuno-assay (CMIA) by (ARCHITECT, Abbott laboratories) fordetecting HIV Ag/Ab, HBsAg. In addition to antibodiesfor HTLV-I/II, Syphilis TP, HCV, HBsAg and anti-HBc.Confirmatory tests are performed through Line ImmunoAssay (LIA) by (FUJIREBIO, Europe N.V.) as a confirma-tory test for the presence of these antibodies. Moreover,(ARCHITECT, Abbott laboratories) Malaria Ag P.f/Pan

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and Enzyme-linked Immunosorbent Assay (ELISA) by(NOVA TEC IMMUNOIAGNOSTICA, GmpH) areused for determination of Plasmodium antigens andantibodies, respectively.

Data collectionThis is a cross-sectional study, conducted using data ofall blood donations received in the period between Janu-ary 2013 and December 2017 at Blood Donor Center inHMC. All data included in the study were retrieved fromthe records anonymously with no identifications of thedonors. An extraction sheet was used, and data wereprovided only as frequencies of positive results for eachscreening test, in addition to basic demographics includ-ing age, gender and nationality of all donors. Tests in-cluded in this study were: HBsAg, HBcAb, HBV NAT,HCV Ab, INNO-LIA HCV, HCV NAT, HTLV-I/II Ab,INNO-LIA HTLV-I, Syphilis Ab and INNO-LIA Syph-ilis, in addition to Malaria Ab and Ag tests. Data forHIV were not included due to its sensitivity, complexity,need for careful handling and unique address with a spe-cific and comprehensive approach.

Data AnalysisData were extracted from the records and entered toMicrosoft excel. Frequencies and percentages were usedfor the description of blood donors by gender, agegroups and nationality. Furthermore, the analysis wasconducted to assess the positivity rate of the transfusiontransmissible infections distribution by age groups, gen-der, and nationality (Qataris and Non-Qataris). Infec-tions positivity rates were calculated for each year toidentify trends throughout the 5 years. Categorical vari-ables were compared using the χ2 test. Test for trend p-value was obtained using multivariable Poisson regres-sion with robust variance modelling the rate of positive

tests to year (as a continuous variable) adjusting for ageand using the proportion of donors in the population asan offset. P-values less than 0.05 were considered statis-tically significant, and Stata/ SE version 15 was used toconduct the analysis.

ResultsA total of 190,509 donations were received at BloodDonor Centre in HMC in the period between January2013 and December 2017. About 91% of the donationswere received from males and 9% from females (Table 1).Moreover, donors of the age group 31–40 years were thehighest to donate blood, with a percentage of 38.6% of thetotal donations during the study period (Table 1). Qatariswere among the top six nationalities to donate blood in allyears of the study (Fig. 1).The positivity rates for all the tests combined (i.e.

screening and confirmatory) were: 1.87, 2.23, 1.78, 2.31,2.67% for the years 2013, 2014, 2015, 2016 and 2017, re-spectively (Fig. 2). Multivariable Poisson regression ana-lysis showed that compared to the year 2013, the age-adjusted incidence rate ratio of positivity for years 2014,2015, 2016 and 2017 were 1.24, 1.02, 1.24 and 1.32, re-spectively. The average age-adjusted rate of positivestests significantly increased by 6% each year (P < 0.001).Furthermore, the positivity rates for tests combined

were compared between male and female donors. Re-sults showed that the rates were more among male do-nors in 2013 through 2015, which was significant onlyfor 2013 and 2014 (P < 0.001). However, in 2016, therates were significantly higher among females (P <0.001), but the difference was again higher among maledonors (P = 0.056) in 2017 (Fig. 3).Assessing the positivity rates among age groups

showed that the rates were higher among young donors,except for the years 2013 and 2014, in which the rates

Table 1 Demographic characteristics of blood donors in Blood Donor Center at HMC in the period 2013 2017

Year 2013 2014 2015 2016 2017 Total

Total Donations 26,153 38,577 42,528 40,865 42,386 190,509

N (%) N (%) N (%) N (%) N (%) N (%)

Gender

Male 24,140 (92.3) 34,961 (90.6) 38,531 (90.6) 37,028 (90.6) 38,577 (91.0) 173,237 (90.9)

Female 2013 (7.7) 3616 (9.4) 3997 (9.4) 3837 (9.4) 3809 (9.0) 17,272 (9.1)

Age Group

≤ 20 770 (2.9) 1276 (3.3) 1194 (2.8) 1357 (3.3) 915 (2.2) 5512 (2.9)

21–30 9035 (34.5) 13,341 (34.6) 14,598 (34.3) 13,847 (33.9) 13,131 (31.0) 63,952 (33.6)

31–40 10,044 (38.4) 14,609 (37.9) 16,112 (37.9) 15,706 (38.4) 16,974 (40.0) 73,445 (38.6)

41–50 4831 (18.5) 6977 (18.1) 7920 (18.6) 7424 (18.2) 8381 (19.8) 35,533 (18.7)

51–60 1337 (5.1) 2142 (5.6) 2429 (5.7) 2264 (5.5) 2644 (6.2) 10,816 (5.7)

> 60 136 (0.5) 232 (0.6) 275 (0.6) 267 (0.7) 341 (0.8) 1251 (0.7)

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were higher in older age groups (P < 0.001), (Table 2).Moreover, when the rates were assessed according to na-tionality throughout the years, it was found that theserates were higher in Non-Qataris compared to Qataristhroughout all the study period (P < 0.001), (Fig. 4).Furthermore, positivity rates of the screening tests were

found to be fluctuating over time, for HBV (P= 0.256), Mal-aria (P= 0.523), Syphilis (P= 0.868) and HCV (P= 0.067).However, trends were increasing for HTLV I/II from 0.08 to0.23 (χ2 = 17.563 and P < 0.001) as shown in (Table 3).

DiscussionEven though blood transfusion saves millions of livesevery year, unsafe blood remains a threat to the spread

of infections. Moreover, it’s also important to addressthe fact that safe blood is considered a universal right,and it should not cause any harm. Thus, it should befully screened and ensured not be contaminated by anytransmissible infection [11].Blood donation centres are among valuable sources of

data, as the prevalence of transfusion transmissible infec-tions among blood donors differs throughout the world,and it can indirectly reflect the burden variations amongthese populations. This is because blood donors are usu-ally representing the healthy members of the communityso that it can have its inferences on the general popula-tion. Currently, the number of registered donors atBlood Donor Center in HMC had increased noticeably

Fig. 1 Percentage of blood donations by nationality in Blood Donors Center at HMC in the period 2013–2017. *Others: Including all nationalitiestogether following the top six ranking nationalities for donation

Fig. 2 Temporal trend of total TTIs prevalence using combined serological and NAT screening (HBsAg, HBcAb, HBV NAT, HCV Ab, INNO-LIA HCV,HCV NAT, HTLV-I/II Ab, INNO-LIA HTLV-I, Syphilis Ab and INNO-LIA Syphilis, in addition to Malaria Ab and Ag tests) among blood donors in blooddonors centre at HMC in the period 2013–2017

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as a result of the continuous promotion, motivation,guidance, and education efforts about the importance ofblood donation, which led to the overall rise in the gen-eral public awareness.In this study, the predominance of blood donations

was by males, which was consistent with several studies[12, 13]. Literature showed that women contribute lessto blood donations than men due to many factors, in-cluding physiological factors such as menstruation, lacta-tion and pregnancy [14]. However, some studies showedthat this difference between gender is much less [15, 16].The predominance of males’ contribution to blood do-

nations was also observed in regards transfusion trans-missible infections positivity rates, as this study showeda consistent predominance throughout most of theyears, in which rates were higher in male donors. Thesewere similar to the findings from studies in the region[17–20].In general, the younger population seems to contribute

more to blood donation, as it was shown in several stud-ies, in which most donors were less than 30 years in age[12, 21, 22]. However, in this study, most of the blood

donors found to be aged 31–40 years old. Additionally,positivity rates of infections were found to be more inthe younger population, which was also found in otherstudies conducted in countries from different regions[21–23].In literature, it has been discussed that young males

are more to be involved in risky behaviours than femalesand older age groups. Moreover, results from severalstudies showed that some donors are involved in riskybehaviour activities, yet they contribute to blood dona-tion. The reason is that they use it to check if they wereinfected with any of the infections that can be related totheir risky behaviours [24–26].In this study, the positivity rates of the combined tests,

including serological and NAT tests, were assessedthroughout the years 2013 to 2017. By assessing theserates during this period, we were able to identify thetrend for these infections, which found to be an increas-ing trend, after adjusting to age and the total population.Despite this increasing trend, yet, the rates were lessthan what was found in countries from different regions,such as Saudi Arabia, Egypt, India and Nigeria [27–30].Moreover, the positivity rates were also assessed for

selected tests throughout the study period. The resultsshowed a fluctuating trend for HBsAg, between 0.34 in2013 and 0.29 in 2017. These rates are less than whathas been found in studies from countries in the regionincluding Saudi Arabia, Kuwait, Jordan and Egypt [31],which can be attributed to the effective prevention andcontrol strategies including vaccination programs [32].The rates for HCV Ab showed a changing trend be-

tween 0.58 in 2013 and 0.70 in 2017. However, theserates are less than the reported from Egypt and SaudiArabia [33], which can be attributed to the high preva-lence of the disease among the general population and

Fig. 3 Gender distribution of positivity rate for combined serological and NAT screening (HBsAg, HBcAb, HBV NAT, HCV Ab, INNO-LIA HCV, HCVNAT, HTLV-I/II Ab, INNO-LIA HTLV-I, Syphilis Ab and INNO-LIA Syphilis, in addition to Malaria Ab and Ag tests) of blood donors in Blood DonorsCenter at HMC in the period 2013–2017

Table 2 Age distribution of positivity rate (%) for TTIs combinedtests of blood donors in Blood Donors Center at HMC, 2013–2017

Age Groups ≤ 20 21–30 31–40 41–50 51–60 > 60 P-value

2013 1.53 1.61 2.06 2.36 2.23 1.39 P < 0.001

2014 2.42 1.87 2.28 2.46 2.32 3.10

2015 2.48 1.47 1.59 1.84 1.63 2.32

2016 4.66 1.73 1.71 1.84 1.83 1.45

2017 6.35 1.72 1.80 1.86 1.54 3.02

Combined Tests: (HBsAg, HBcAb, HBV NAT, HCV Ab, INNO-LIA HCV, HCV NAT,HTLV-I/II Ab, INNO-LIA HTLV-I, Syphilis Ab and INNO-LIA Syphilis, in addition toMalaria Ab and Ag tests)

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the migration from these countries to other countrieswith lower prevalence [34]. This was consistent withfindings from our study, as the rates were higher amongthe Non-Qataris throughout the years. However, therates were higher than what was reported from othercountries in the same region (i.e. middle east region),like Iran and Turkey [33].Furthermore, screening for HTLV is also among the

recommended screening for transfusion, and this in-cludes two viruses: I and II that differs in their geo-graphical distribution and clinical disease association.HTLV is endemic in some parts of the world, and insome regions, the prevalence of the virus is very low, asthe situation here in Qatar.The cost-effectiveness of the universal screening strat-

egies for HTLV has been argued. This was especially forthe screening implementation by high-income countrieswith a low prevalence of the infection [35, 36]. Qatar isamong these countries. However, it is a destination forworking force from all around the world, including areasendemic with the virus. Therefore, HTLV is among thescreening requirements for blood safety in the country.The positivity rate for HTLV I/II Ab in 2017 found to

be 0.23, which represents an increasing trend from 0.08 in2103. Further analysis for the findings showed that thepositivity rates were more in Non-Qataris than Qataris forthe screening test, but zero positivity among Qataris forthe confirmatory test (i.e. INNO-LIA), which is consistentwith epidemiological distribution of the disease, consider-ing Qatar as low prevalence area for HTLV [7].Donors can threaten blood safety with risky behaviour

as they may potentially acquire syphilis, among other in-fections. In this study, the positivity rates for Syphilis Abamong donors throughout the years showed a fluctuat-ing trend that reported to be 0.48 in 2013 and to be 0.45in 2017, and these rates were higher in Non-Qatarithroughout the years. Yet, these rates were less thanwhat was found in studies in neighbouring countries,such as Saudi Arabia [12, 37]. Moreover, it’s importantto consider the fact that a specific assay has been usedto screen for syphilis (i.e. Treponema pallidum Ab),which leads to identifying whoever has been infectedwith syphilis, whether it is a recent or past infection, andwhether it was treated or not, which may result in over-estimation of the disease burden [35].Another serious infectious agent that remains to risks

blood safety is transfusion-associated malaria. The coun-try is free from local transmission of malaria, and all thereported cases were imported from abroad, through mi-grants and travellers from endemic countries. Findingsfrom our study are consistent with the situation amongthe general population, as the rates of positivity for Mal-aria Ag were found to be higher among Non-Qataristhroughout the years. Moreover, assessing these ratesthroughout the year revealed a fluctuating trend. Add-itionally, the overall positivity rate to the regionalcountries showed similar rate to Saudi Arabia, buthigher than the United Emirates and less thanPakistan [38, 39].

Fig. 4 Positivity rate (%) for TTIs tests combined: (HBsAg, HBcAb, HBV NAT, HCV Ab, INNO-LIA HCV, HCV NAT, HTLV-I/II Ab, INNO-LIA HTLV-I,Syphilis Ab and INNO-LIA Syphilis, Malaria Ab and Ag tests) of blood donors (Qatari Vs Non-Qatari) in Blood Donors Center at HMC in theperiod 2013–2017

Table 3 Temporal trends positivity rate (%) for screeningamong blood donors in Blood Donors Center at HMC in theperiod 2013–2017

Year 2013 2014 2015 2016 2017 Overall P-value

HCV Ab 0.58 0.58 0.56 0.60 0.70 0.60 0.067

HTLV I/II Ab 0.08 0.16 0.20 0.22 0.23 0.18 < 0.001

Syphilis Ab 0.48 0.49 0.35 0.41 0.45 0.43 0.868

HBsAg 0.34 0.28 0.31 0.26 0.29 0.30 0.256

Malaria Ag 0.14 0.24 0.42 0.10 0.10 0.20 0.523

Screening Tests: (HCV Ab, HBsAg, HTLV I/II Ab, Syphilis Ab and Malaria Ag)

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Finally, it is essential to highlight the fact that the vari-ance in the prevalence of the transfusion transmissibleinfections among blood donors from different countriescan be a reflection of an actual variance of the preva-lence in these countries, in addition to the differentmethods used to test for these infections which can re-sult in different estimations [40, 41].In summary, the overall positivity rate of transfusion

transmissible infections among blood donors was assessedthrough combined serological in addition to NAT tests,and results revealed a gradually increasing trend through-out the years, with 6% increase for each year. However,this study also revealed fluctuating trends for HBV, HCV,Syphilis and Malaria. In addition to the increasing trendfor HTLV. Further analysis revealed that rates were higheramong Non-Qataris throughout the years.Despite the important study findings, some limitations

are worth to be mentioned. Among which is the fact thatthis is a retrospective study conducted by utilizing re-cords in the blood donor centre. The study was limitedto the available data in these records only, which in-cluded tabulated results of the screening tests by basicdemographics (i.e. age, gender, nationality). Populationdata was not available for all basic demographics’ cat-egories, thus limiting some of the analysis that accountsfor populations changes. Moreover, the study wouldhave benefited from a longer period exceeding thecurrent period from 2013 to 2017. Another limitation isnot including data about HIV, due to the sensitivity andthe complexity of these data. Finally, it was not possibleto assess the outcome of donors with positive results forany of the infections, as the donation records are notconnected with the medical records.

ConclusionIn spite of the previously discussed limitations, this studystill provides important findings that contribute to a bet-ter understanding of TTIs epidemiology. Up to ourknowledge, this is the first study to assess the prevalenceand trends of TTIs, including HBV, HCV, HTLV, Syph-ilis and Malaria among blood donors in Qatar. Furtherinvestigations are needed to assess the distribution anddeterminants of these infections in the community tosupport the development of effective prevention andcontrol strategies and to protect the community frompotential risks.

AbbreviationsAnti-HBc: Antibody to Hepatitis B core antigen; CMIA: ChemiluminescentMicroparticle Immunoassay; CMV: Cytomegalovirus; ELISA: Enzyme-linkedImmunosorbent Assay; GDBS: Global Database on Blood Safety;HBsAg: Hepatitis B surface Antigen; HBV: Hepatitis B Virus; HCV: Hepatitis CVirus; HIV: Human Immunodeficiency Virus; HMC: Hamad MedicalCorporation; HTLV-I/II: Human T-cell Lymphotropic Virus; LIA: Line ImmunoAssay; TSE: Transmissible Spongiform Encephalopathy; TTIs: Transfusion

Transmissible Infections; WHO: World Health Organization; WNV: West NileVirus

AcknowledgementsThe authors gratefully acknowledge the Blood Donation Center at HMC fortheir support.

Authors’ contributionsAuthors participated in the study design, data analysis, results’ interpretation,in addition to manuscript reviewing and writing. All authors read andapproved the final manuscript. MA, NS and SH contributed substantially tothe conception, study design and writing the manuscript. SAH, ZM and NAparticipated in data acquisition, extraction and determining study variables.MEA, AA, SK and EF contributed in data analysis, and HEA, MAT, MD and SAinterpreted the study outcomes and the impact on the policy development.

FundingThis study did not receive any financial support.

Availability of data and materialsThe data that support the findings of this study are available from BloodDonation Center at HMC and were used under license for the current study,and so are not publicly available. Data are however available from theauthors upon reasonable request and with permission of Blood DonationCenter.

Ethics approval and consent to participateThis study was approved by the Institutional Review Board (IRB) at theMedical Research Center, Hamad Medical Corporation, Doha-Qatar under theprotocol number MRC-01-18-374, with a decision of ‘Exempt’. Prior to thedata use in this study, it was anonymised and de-identified by the Blood Do-nation Center at Hamad Medical Corporation. The administrative permissionswere granted by the Head of Lab Medicine and Pathology Department andthe Medical Director of Hamad General Hospital at Hamad MedicalCorporation.

Consent for publicationN/A

Competing interestsThe authors declare that they have no competing interests.

Author details1Community Medicine Training Program- Medical Education, Hamad MedicalCorporation, P.O. Box 3050, Doha, State of Qatar. 2Community MedicineTraining Program- Primary Health Care Corporation, Doha, Qatar. 3Faculty ofMedicine- Cairo University, Cairo, Egypt. 4Public Health Department- Ministryof Public Health, Doha, Qatar. 5Blood Donation Unit- Hamad MedicalCorporation, Doha, Qatar. 6College of Health Sciences- Department of PublicHealth, Qatar University, Doha, Qatar. 7Gastroenterology and HepatologyDepartment- Hamad Medical Corporation, Doha, Qatar.

Received: 17 September 2019 Accepted: 13 August 2020

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